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Öğe Clinical Significance of Incidental FDG Uptake in the Prostate Gland Detected by PET/CT(E-Century Publishing Corp, 2015) Şahin, Ertan; Elboğa, Umut; Kalender, Ebuzer; Başıbüyük, Mustafa; Demir, Hasan Deniz; Çelen, Y. ZekiThe value of FDG-positron emission tomography/computed tomography (PET/CT) for detecting prostate cancer is unknown. We aimed to investigate the clinical value of incidental prostate FDG uptake on PET/CT scans. We reviewed 6128 male patients who underwent FDG-PET/CT scans and selected cases that reported hypermetabolic lesion in the prostate. The patients who have prior history of prostate carcinoma or prostate surgery were excluded from the study. We have analyzed the correlation between PET/CT findings and serum prostate-specific antigen (PSA) levels, imaging (USG), urological examinations and biopsy. Incidental 18F-FDG uptake of the prostate gland was observed in 79 patients (1.3%). While sixteen of them were excluded due to inadequate clinical data, the remaining 63 patients were included for further analysis. The patients were divided into two groups; 8 patients (12.7%) in the malignant group and 55 patients (87.3%) in the benign group. The SUVmax values were not significantly different between the two groups. In 6 (75%) patients with prostate cancer, FDG uptake was observed focally in the peripheral zone of the prostate glands. There was no significant correlation between the SUVmax and the PSA levels. Incidental 18F-FDG uptake in the prostate gland is a rare condition, but a substantial portion of it is associated with the cancer. Benign and malignant lesions of the prostate gland in FDG-PET/CT imaging could not be reliably distinguished. The peripheral focally FDG uptake of prostate glands should be further examined with the clinical and labaratory evaluations.Öğe Clinical Significance of Incidental FDG Uptake in the Prostate Gland Detected by PET/CT (Meeting Abstract)(Soc Nuclear Medicine Inc, 2015) Şahin, Ertan; Elboğa, Umut; Kalender, Ebuzer; Başıbüyük, Mustafa; Demir, Hasan Deniz; Çelen, Y. Zeki[No Abstract Available]Öğe Effect of short term thyroxin withdrawal on health related quality of life in differentiated thyroid carcinoma patients(In House Publications, 2015) Elboğa, Umut; Elboga, G.; Kalender, Ebuzer; Demir, Hasan Deniz; Şahin, Ertan; Başıbüyük, Mustafa; Özkaya, M.Background: We aimed to study the HRQL in patients with differentiated thyroid carcinoma (DTC) during hypothyroidism due to thyroxin withdrawal, which is induced routinely for iodine-131 (I-131) whole body scan and ablative treatment. Methods: Between September 2011 and March 2012, eligible patients with DTC who were referred to our institution for diagnostic or therapeutic radioiodine administration under hypothyroid conditions due to thyroid hormone withdrawal were asked to complete the psychological instruments rating their HRQL and psychological status. HRQL was studied using the Short Form (SF-36), Hospital Anxiety and Depression Scale (HADS), Profile of Mood States (POMS), the total mood disturbance (TMD) score, Beck Depression Inventory (BDI).One hundred and forty three hypothyroid patients with DTC (F=101, M=42, age=58.7 yrs) who were also on low-iodine diet were included in this study. Hypothyroidism was induced by withdrawal of thyroxin replacement in all patients. Results: The results of SF-36 showed that the HRQL was significantly impaired in hypothyroid patients during withdrawal of thyroxin (physical component scale: 44.3 ± 9.5, mental component scale: 40.8 ± 10.2, p ? 0.001). Depression scores were in the normal or non-clinically relevant range: 4.1 ± 3.8 on the HADS-Depression and 8.3 ± 6.6 on the Beck Depression Index. However, the mean score of 28.8 ± 25.2 on the POMS TMD was within normal range. Conclusion: HRQL is impaired in hypothyroid patients with DTC during thyroxine withdrawal before I-131 whole body scan and radioiodine therapy. © 2015 Elboga U, et al.Öğe Empiric I-131 Treatment of High Thyroglobulin Levels in Differentiated Thyroid Carcinoma After Remnant Ablation(Carbone Editore, 2014) Kalender, Ebuzer; Elboğa, Umut; Çelen, Y. Zeki; Demir, Hasan Deniz; Şahin, Ertan; Karacavuş, SeyhanAim: The objective of this study is to establish the efficacy of empiric 1-131 treatment (EIT) given for patients whose thyroglobulin(Tg) levels remained high after ablative 1-131 treatment (AIT). Methods: Fifty-six patients (46 women, 10 men; mean age 47.4 +/- 16.8), without distant metastasis, who were treated empirically for high Tg levels after AIT in our clinic, were retrospectively studied. In all patients stimulated Tg levels before AIT (Tg I) and 6 months after AIT (Tg II) were measured. After EIT, post-therapeutic whole-body scintigraphy (PWBS) was performed to all patients. 18F-FDG PET CT was performed to patients who had negative PWBS but continued to have high Tg II levels. Results: PWBS was positive in 28 patients (50%) and negative in 28 patients (50%). Twenty-eight patients did not respond to EIT (50%), and 28 patients (50%) responded to EIT at different rates. Sixteen patients (28.6%) responded to EIT completely, and 12 patients (21.4%) responded to EIT partially. Tg I was 60.7 +/- 40 ng/ml and Tg H was 31 +/- 20.4ng/ml in responding patients, whereas Tg I was 87 ng/ml and Tg II was 114.3 +/- 106 ng/ml in unresponding ones. 18F-FDG PET CT was positive in 22 patients and negative in 6. Conclusion: Our findings, suggested that the EIT is not beneficial in patients who have higher Tg II than Tg land the cure rate is low in increasing Tg levels. The patients who have high Tg II but lower than Tg I can be treated empirically with 1-131.Öğe Evaluation of conventional imaging techniques on preoperative localization in primary hyperparathyroidism(Assoc Basic Medical Sci Federation Bosnia & Herzegovina Sarajevo, 2015) Özkaya, Mesut; Elboğa, Umut; Şahin, Ertan; Kalender, Ebuzer; Korkmaz, Hakan; Demir, Hasan Deniz; Maralcan, GöktürkWe aimed to evaluate the diagnostic and preoperative localization capacity of Tc-99m methoxyisobutylnitrile (MIBI) parathyroid scintigraphy and ultrasonography (USG) in enlarged parathyroid glands in the primary hyperparathyroidism (pH PT), as well as the relationship between the success rate of these techniques and biochemical values. We retrospectively evaluated 39 patients with clinical and biological evidence of pHPT who referred to the university hospital for MIBI parathyroid scintigraphy. Patients were examined with USG and double-phase MIBI parathyroid scintigraphy for the detection of enlarged parathyroid glands. Preoperative serum intact parathyroid hormone (iPTH) levels, calcium (Ca), phosphate and alkaline phosphatase measurements were obtained. A total of 45 parathyroid lesions in 39 patients were reviewed. Thirty-four patients had a single adenoma and five patients with multi-gland disease had 11 abnormal parathyroid glands including three adenomas, whereas the remaining 8 glands showed hyperplasia. The overall sensitivities of MIBI parathyroid scintigraphy, USG, and combined techniques were 85.3%, 72.5% and 90.4%, respectively; the positive predictive values (PPV) were 89.7%, 85.2%, and 92.6%, respectively. The most successful approach for detection of enlarged parathyroid glands in hyperparathyroidism is the concurrent application of USG and MIBI parathyroid scintigraphy modalities. The concomitance of thyroid diseases decreases the sensitivity of both MIBI parathyroid scintigraphy and USG in enlarged parathyroid glands.Öğe F-18 FDG PET/CT imaging in the diagnostic work-up of thyroid cancer patients with high serum thyroglobulin, negative I-131 whole body scan and suppressed thyrotropin: 8-year' experience(Verduci Publisher, 2015) Elboğa, Umut; Karaoğlan, H.; Şahin, Ertan; Kalender, Ebuzer; Demir, Hasan Deniz; Başıbüyük, Mustafa; Özkaya, M.OBJECTIVE: Fluorodeoxyglucose positron emission tomography/computed tomography imaging in the follow-up of patients with differentiated thyroid carcinoma who have high serum thyroglobulin, negative iodine-131 whole body scan and suppressed thyrotropin. PATIENTS AND METHODS: A total of 90 patients (31 male and 59 female) with differentiated thyroid carcinoma who have high serum thyroglobulin and negative iodine-131 whole body scan were included in the study between July 2006 and March 2014. All patients had undergone surgery (total thyroidectomy +/- lymph node dissection) followed by iodine-131 ablation. Of the patients, 82 had papillary thyroid carcinoma and 8 follicular thyroid carcinoma. Serum thyrotropin was suppressed (< 2 mu IU/ml) during the Fluor-18 fluorodeoxyglucose positron emission tomography/computed tomography imaging procedure. RESULTS: The overall sensitivity of fluor-18 fluorodeoxyglucose positron emission tomography/computed tomography imaging in the detection of metastasis of differentiated thyroid cancer was 84.8%, the specificity 79.1%, respectively. The sensitivity and specificity of fluor-18 fluorodeoxyglucose positron emission tomography/computed tomography imaging in classic type of papillary cancer was 83.3% and 54.5%, respectively. The corresponding figures for the tall cell variant was 85.7% and 87.5%, respectively. The difference between the two histological subtypes was statistically significant (p < 0.05). CONCLUSIONS: Our results suggest that fluor-18 fluorodeoxyglucose positron emission tomography/computed tomography imaging could be a valuable test for the routine follow-up of patients with differentiated thyroid carcinoma.Öğe Incidental Thyroid Lesions Detected with FDG PET Scanning(Carbone Editore, 2014) Kalender, Ebuzer; Elboğa, Umut; Çelen, Y. Zeki; Demir, Hasan Deniz; Şahin, Ertan; Yılmaz, M.; Özkaya, M.Aims: fluorodeoxyglucose Positron EmissionTomography(FDG PET) scanning has become more popular in recent years, it has also become more frequent means of detecting incidental thyroid lesions. The aim of this study is to investigate to prevalence of incidentally found thyroid lesions in patients undergoing FDG PET and determine the risk for thyroid cancer. FDG PET was performed on 5758 patients for evaluation of suspected or known cancer without any history of thyroid disease between January 2006 and May 2012 in our clinic. Material and methods: Patients with incidental thyroid abnormalities were identified. Medical records related to the FDG PET findings including standardized uptake value(SUV) and pattern of FDG uptake, fine needle aspiration(FNA) diagnosis and histopathology after thyroid surgery were reviewed retrospectively. Results: One hundred twenty three patients (2.1%) were identified to have focal incidental thyroid lesions and 52 patients (0.9%) were identified diffuse incidental thyroid lesions on FDG PET. Twenty-four patients with focal and 5 patients with diffuse incidental thyroid lesion underwent FNA. The malignant diagnosis was detected in 41.6% of focal lesions. In diffuse lesions, malignant diagnosis was not observed. There was a significant difference in the SUVmax between the benign and malignant lesions (5.7 +/- 2.2 and 10.1 +/- 5 3). Malignant diagnosis was noted in 57.1% of male patients and 20% of female patients who underwent FNA. Conclusion: The results of this study suggest that focal FDG uptake, high SUV and male gender have high risks for thyroid malignancy in incidentally found thyroid lesions by FDG PET. Further diagnostic work-up is needed in patients with these findings.Öğe Medüller Tiroid Karsinomalı Hastaların Takibinde Fdg Pet(2014) Kalender, Ebuzer; Demir, Hasan Deniz; Elboğa, Umut; Karaoğlan, Hüseyin; Şahin, Ertan; Çelen, Y. ZekiAmaç: Çalışmanın amacı cerrahi sonrası yüksek kalsitonin seviyelerine sahip medüller tiroid karsinomlu (MTK) hastaların takibinde florodeoksiglikoz pozitron emisyon tomografisinin (FDG PET) etkinliğini değerlendirmektedir. Gereç ve Yöntemler: Çalışmaya yüksek kalsitonin seviyeleri nedeniyle kliniğimize FDG PET görüntüleme için yönlendirilen MTK tanılı 6 hasta dahil edildi. Bütün hastalar erkekti. Yaş ortalaması 52±8 idi. Bulgular: Kalsitonin seviyeleri sırasıyla75 pg/ml, 90pg/ml, 94 pg/ml ve 127 pg/ml olan 4 hastada FDG PET görüntülemede MTKnın rekürrens ya da metastazını düşündürecek bulgu izlenmedi. Kalsitonin seviyeleri 1300 pg/ml ve 2110 pg/ml olan 2 hastada ise FDG PET bulguları pozitifti. Bu hastalarda lenf nodu ve kemik metastazları saptandı. Tartışma: Öyle görünüyor ki MTKnın rutin görüntülemesinde FDG PETe yer yoktur. Ancak burada kalsitonin seviyeleri önem arz etmektedir. Kalsitonin seviyeleri 1000 pg/mlden yüksek hastalarda FDG PET oldukça faydalı olabilmekte ve birçok lezyon odağını tespit edebilmektedir. Ayrıca tüm vücut görüntülemeye olanak sağlaması da önemli bir avantajıdır.Öğe Radioiodine ablation treatment induced pill esophagitis: A case report(Acta Medica Mediterranea, 2015) Elboğa, Umut; Dag, Muhammed Sait; Tutar, Ediz; Şahin, Ertan; Kalender, Ebuzer; Demir, Hasan Deniz; Çelen, Y. ZekiCapsule form of the drugs is more risk for pill-induced esophagitis. Radioiodine ablation is recommended for well differentiated thyroid cancer primary tumors >1 cm in diameter. In ablation, it is aimed to "ablate" the remaining healthy thyroid tissue. We present a case of a 23-year-old woman with complaints of severe odynophagia, dysphagia and retrosternal pain 3 days in which radioiodine ablation treatment was the cause of pill-induced esophagitis. She complained after she had undergone to radioiodine ablation treatment for papillary thyroid carcinoma. She had a history of swallowing I-131 capsule with about 150 ml water in the upright position. An upper endoscopic examination demonstrated two superficial kissing ulcers about 1 cm diameter in the middle of the esophagus. Pantoprazole and sucralfate treatment was started. Symptoms improved seven days after starting this treatment. The esophagus was completely normal in control endoscopy after two weeks. Radioiodine ablation treatment with I-131 capsule may cause esophageal lesions; therefore, patients should be educated by nuclear medicine physicians about the possible side effects of this treatment.Öğe Radioiodine Ablation Treatment Induced Pill Esophagitis: A Case Report(Carbone Editore, 2015) Elboğa, Umut; Dag, Muhammed Sait; Tutar, Ediz; Şahin, Ertan; Kalender, Ebuzer; Demir, Hasan Deniz; Çelen, Y. ZekiCapsule form of the drugs is more risk for pill-induced esophagitis. Radioiodine ablation is recommended for well differentiated thyroid cancer primary tumors >1 cm in diameter. In ablation, it is aimed to ablate the remaining healthy thyroid tissue. We present a case of a 23-year-old woman with complaints of severe odynophagia, dysphagia and retrosternal pain 3 days in which radioiodine ablation treatment was the cause of pill-induced esophagitis. She complained after she had undergone to radioiodine ablation treatment for papillary thyroid carcinoma. She had a history of swallowing I-131 capsule with about 150 ml water in the upright position. An upper endoscopic examination demonstrated two superficial kissing ulcers about 1 cm diameter in the middle of the esophagus. Pantoprazole and sucralfate treatment was started. Symptoms improved seven days after starting this treatment. The esophagus was completely normal in control endoscopy after two weeks. Radioiodine ablation treatment with I-131 capsule may cause esophageal lesions; therefore, patients should be educated by nuclear medicine physicians about the possible side effects of this treatment.Öğe Regional Distributions of Distant Metastases Detected in Differentiated Thyroid Cancers(Derman Medical Publ, 2015) Kalender, Ebuzer; Elboğa, Umut; Aydogan, Fusun; Başıbüyük, Mustafa; Demir, Hasan Deniz; Şahin, Ertan; Çelen, Y. ZekiAim: The aim of our multicenter study is to determine retrospectively the regional distributions of distant metastases which are detected in differentiated thyroid cancers (DTC). Material and Method:Thirty-two of 960 patients with distant metastases who were given radioiodine (RAI) treatment in Gaziantep University School of Medicine and Mustafa Kemal University School of Medicine were included to study. Six of patients were male, 26 of them were female. Mean age was 52 15.4. Hystopathological diagnoses were reported as papillary thyroid cancer in 23 patients and folliculary thyroid cancer in 9 patients. The distant metastasis ratio, metastasis regions and distributions were determined. Results: It was observed only lung metastasis in 18 (56.25 b), only bone metastasis in 6 (18.75 To), combination of lung and bone metastases in 3 (9.4 %), other organ metastases accompanying to bone and lung metastases in 5 (9.4 %) (liver, soft tissue, mediastinum) and multipl organ involvoment in 2 (6.2 96) of patients. It was determined single metastasis region in 24 (75 To), 2 metastasis regions in 6 (18.75 glo) and multipl metastasis regions in 2 (6.25 WO of patients. Discussion: Distant metastases are the biggest problem in treatment and follow-up of DTCs. It is very important to diagnosis of metastases and determine the regions of involvoment in these patients.Öğe Relationship between the infarct localization and left ventricular rotation parameters following acute ST-segment elevation myocardial infarction(Turkish Soc Cardiology, 2020) Demirkiran, Aykut; Zorkun, Cafer Sadık; Demir, Hasan Deniz; Topçu, Birol; Emre, Ender; Özdemir, NihalOjective: This study was an investigation of the role of left ventricular (LV) apical rotation seen in the early period after myocardial infarction (MI) in predicting infarct localization. Methods: A total of 124 patients with a ST-Segment elevation myocardial infarction (STEMI) diagnosis who underwent primary percutaneous coronary intervention (PCI) and 50 healthy volunteers with similar demographic characteristics were included in the study. The relationship between 2-dimenstional speckle tracking echocardiography (STE)-guided LV apical rotation angle measurements and technetium-99m sestamibi-single-photon emission computed tomography (SPECT)-guided infarct localization was evaluated. Conventional echocardiography and STE were performed on average 2 days after PCI, and gated SPECT myocardial perfusion imaging (MPI) was performed within an average of 60 days. Results: The apical rotation angle was lower in patients with an anterior MI compared with those who had an inferior MI and the control group (AntMl-InfMl: 6.51 +/- 2.4 degrees, AntMI-Control: 13.20 +/- 2.5 degrees, InfMI-Control: 14.3 +/- 2.1 degrees, p value: 0.00, 0.00, 0.15, respectively). SPECT MPI analysis revealed the presence of an LV apical scar in all patients with acute anterior MI, but only 14 of those with inferior MI group (usually the inferoapical wall). The apical rotation angle recorded in patients with apical scar was lower than that of the patients without apical scar (7.6 +/- 2.8 degrees and 14.5 +/- 2 degrees, respectively; p=0.00). Receiver operating characteristic curve analysis yielded an area under the curve for apical rotation of 0.799 (p<0.01). The optimal cutoff value of 12.1 degrees had a sensitivity of 78.3% and a specificity of 68.2% for predicting LV apical scar following STEMI. Conclusion: Detection of apical rotation angle decrease in the early period after STEMI may be useful in predicting extension of infarct scarring to the LV apex.Öğe The Evaluation of Patients with Hyperthyroidism Treated with Radioactive Iodine-131(Derman Medical Publ, 2015) Başıbüyük, Mustafa; Elboğa, Umut; Çelen, Y. Zeki; Kalender, Ebuzer; Demir, Hasan Deniz; Şahin, Ertan; Özkaya, MesutAim: Hyperthyroidism is a condition in which the thyroid gland produces and secretes excessive amounts of the thyroid hormones into circulation. It is one of the common endocrinologic disorders. There are three methods in treatment of hyperthyroidism. These are antithyroid medication, radioactive iodine-131 (RAI) therapy and surgery. In this study, we aimed to evaluate RAI treatment efficacy in patients with hyperthyroidism in the light of laboratory results and clinical pictures. Material and Method: Two hundred and seventy six patients with hyperthyroidism (average age: 50.9 years, age range: 1882 years) who received RAI treatment and then followed up for at least 6 months were included in the study. Patients' medical recordings were analysed retrospectively. Results: Seventy one patients were men (average age: 51.2 years, age range: 18-80 years), the rest were women (average age: 50.7 years, age range: 18-82 years). According to thyroid ultrasound or physical examination findings, 102 patients had diffuse thyroid hyperplasia, the other patients had nondiffuse hyperplasia (nodular or multinodular). RAI was given to the patients once or twice, or three times if necessary. In first RAI treatment, average 13.1 mCi, in second, average 16.6 mCi, in third, average 25 mCi RAI were given orally. Treatment was accepted as successful if the patients had become hypothyroid or euthyroid. Success rate of RAI treatment was 76%. The highest success rate was obtained in patients who have diffuse thyroid hyperplasia. Serious side-effects were not observed in our patients. Discussion: In treatment of hyperthyriodism with RAI in our clinic we observed approximately similar success rates with the reported results in the literature, and also side-effects of RAI treatment were low. We believe that RAI treatment should be first choice for treatment of hyperthyroidism in selected patients, because it is easy to perform and its side- effects are very low.
